Journal Of Cardiothoracic Surgery[JOURNAL]
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200 papers
Perioperative hyperoxia versus normoxia during cardiopulmonary bypass in adult cardiac surgery: a systematic review and meta-analysis of randomized controlled trials.
AlSejari NY, Aljaber BH, Alyahya SA … +3 more , Alharran AM, Abdul-Hafez HA, Alsubaiei AA
J Cardiothorac Surg · 2026 Jun · PMID 42271504 · Full text
BACKGROUND: While hyperoxia has conventionally been the standard during cardiopulmonary bypass (CPB) to prevent hypoxemia, recent concerns regarding oxygen-induced oxidative stress have sparked debate over whether a norm...
BACKGROUND: While hyperoxia has conventionally been the standard during cardiopulmonary bypass (CPB) to prevent hypoxemia, recent concerns regarding oxygen-induced oxidative stress have sparked debate over whether a normoxic strategy provides a safer clinical alternative. METHODS: A comprehensive search of PubMed, Web of Science, CENTRAL, and Scopus was conducted to identify randomized controlled trials (RCTs) through December 2025. Primary outcomes included short-term and long-term mortality, and acute kidney injury (AKI). Secondary outcomes included assessment of clinical complications and healthcare resource utilization. Risk ratios (RR) and mean differences (MD) were pooled using a random-effects model. RESULTS: Twelve RCTs involving 2,732 patients were included. The analysis found no significant difference between hyperoxia and normoxia in short-term mortality (RR: 1.23, 95% CI [0.60, 2.54]; p = 0.57), long-term mortality (RR: 1.10, 95% CI [0.84, 1.43]; p = 0.48), or the incidence of AKI (RR: 0.94, 95% CI [0.82, 1.07]; p = 0.32). Similarly, no significant differences were observed in secondary clinical outcomes, including myocardial infarction, stroke, arrhythmia, or surgical site infections. Hospital resource utilization was comparable, with no significant differences in mechanical ventilation duration (p = 0.06), ICU stay (p = 0.32), or length of hospital stay (p = 0.08). CONCLUSION: This meta-analysis detected no statistically significant differences between hyperoxic and normoxic strategies during CPB regarding mortality, clinical outcomes, or hospital resource utilization. Still, the current evidence remains uncertain, warranting further research.
Effect of a water-soluble alkylene oxide copolymer based bone hemostat in cardiac surgery: a prospective, multicenter, single-arm study.
Yamane K, Masood MF, Wang S … +3 more , Micallef L, Parreno R, Pinto FCM
J Cardiothorac Surg · 2026 Jun · PMID 42271503 · Full text
OBJECTIVES: This study evaluated the safety and effectiveness of an Alkylene Oxide Copolymer, Ostene, in controlling bone bleeding in open cardiac surgical patients undergoing median sternotomy. DESIGN: Single arm, prosp...
OBJECTIVES: This study evaluated the safety and effectiveness of an Alkylene Oxide Copolymer, Ostene, in controlling bone bleeding in open cardiac surgical patients undergoing median sternotomy. DESIGN: Single arm, prospective, post-market study. SETTING: This study was conducted at 3 centers in the United States. PARTICIPANTS: Ninety adult median sternotomy patients in whom Ostene was intended to be bone hemostat. INTERVENTIONS: Ostene used to treat bone bleeding during surgical procedure. MEASUREMENTS AND MAIN RESULTS: Surgical parameters included the area of bone bleeding, severity of bleeding, quantity of Ostene used to stop bone bleeding, time for bone bleeding to stop, time to occurrence of a bone rebleed, and the number of Ostene applications. The use and rationale for using an alternate bone hemostat were also recorded in cases where alternate bone hemostats were used. Adverse events that started from the time of the index procedure until 30 days postoperatively were also recorded. MAIN RESULTS: Intraoperative bone bleeding was successfully controlled with the application of Ostene in 87 of 89 patients (97.8%) who were eligible for effectiveness analyses. Intraoperative rebleeds were observed in 23 of 90 patients (25.6%) 238.1 ± 61.7 min after hemostasis of the original bleed was achieved. Final hemostasis was achieved by reapplying Ostene in 21 patients and alternate bone hemostats in 2 of the 23 patients. None of the patients in the study had postoperative bone bleeding within 24 h of surgery. Few AEs occurred in the study cohort, all unrelated to Ostene. CONCLUSIONS: Ostene proved to be effective bone hemostat for the control of intraoperative bone bleeding in cardiac surgical patients undergoing median sternotomy.
Novel percutaneous retrieval of a self-entangled decapolar catheter using a deflectable sheath and guidewire counter-traction.
Chang KH, Wu LC, Lee CT … +4 more , Lin CY, Lin SI, Liao FC, Lee YH
J Cardiothorac Surg · 2026 Jun · PMID 42271502 · Full text
Catheter entanglement is an uncommon but potentially serious complication during electrophysiological procedures. This is a rare case of self-entanglement of a diagnostic decapolar catheter during cryoablation for persis...
Catheter entanglement is an uncommon but potentially serious complication during electrophysiological procedures. This is a rare case of self-entanglement of a diagnostic decapolar catheter during cryoablation for persistent atrial fibrillation. A 61-year-old man underwent catheter-based rhythm control therapy under conscious sedation. During coronary sinus cannulation, the catheter unexpectedly prolapsed and formed a self-loop within the right atrium. Repeated manipulation and traction resulted in progressive tightening of the loop around the Eustachian valve region and adjacent right atrial structures, making conventional withdrawal unsuccessful. Inferior vena cava venography demonstrated marked venous tortuosity, which likely impaired torque transmission and contributed to uncontrolled catheter rebound and looping. A bailout retrieval strategy using a right internal jugular approach, an Attain™ deflectable delivery system, guidewire-assisted loop stabilization, and EN Snare counter-traction successfully released the entrapped catheter without surgical intervention or structural injury. This case highlights a reproducible percutaneous retrieval strategy for complex right atrial catheter entanglement.
Risk factors analysis and prediction models of atrial fibrillation/flutter after esophagectomy.
Ji M, Pang X, Liu X … +1 more , Jiang B
J Cardiothorac Surg · 2026 Jun · PMID 42271500 · Full text
BACKGROUND: Postoperative atrial fibrillation/flutter (POAF) increases postoperative complications and hospitalization time. Identifying those at risk of atrial fibrillation/flutter after major thoracic surgery allows pr...
BACKGROUND: Postoperative atrial fibrillation/flutter (POAF) increases postoperative complications and hospitalization time. Identifying those at risk of atrial fibrillation/flutter after major thoracic surgery allows prophylactic therapy to be targeted toward those most likely to benefit. OBJECTIVE: A clinical prediction model for POAF in cancer patients undergoing esophagectomy was developed and validated to identify the incidence and clinical correlates of POAF. METHODS: 623 patients undergone radical esophagectomy for cancer were included. The POAF prediction models were constructed using a backward selection strategy by starting with factors with p ≤ 0.1 in univariable analyses. Influence factors with a multivariate P < 0.05 were defined as statistically significant. The discrimination of the models was determined by calculating the AUC of the ROC curve. Goodness-of-fit of the model was evaluated by Hosmer-Lemeshow test. Calibrating, nomogram and randomForest algorithm were also applied to develop the prediction model. RESULTS: The end point of the study, POAF, occurred in 25.5% of patients (159/623) at a median of 2 days. In univariable analyses, the differential factors associated with atrial fibrillation/flutter including age (median, 67 vs. 64 years; p < 0.0001), male (94% vs. 88%; p = 0.022), hypertension (42% vs. 31%; p = 0.019), FEV1/FVC (median, 74.89 vs. 77.06%; p = 0.010), premature atrial contraction (PAC, 42% vs. 15%; p < 0.0001), left atrial dilation (15% vs. 5%; p = 0.0002), preoperative neutrophilic granulocyte percentage (GRA, median, 65.8 vs. 63.7%; p = 0.013). The AUC of this model is 0.725. Postoperative viables were also included in another model, which prediction efficiency is better than the former. (AUC = 0.736) CONCLUSION: We developed two predictive models identified preoperative and postoperative risk factors and targeted preventive therapy would be administered in selected patients.
Right axillary thoracotomy versus median sternotomy for repair of subarterial ventricular septal defect in adolescents and adults.
Li J, Qu Y, Han Z … +6 more , Lv L, Duan Y, Xing G, Li G, Cao Y, Wang Q
J Cardiothorac Surg · 2026 Jun · PMID 42271495 · Full text
Subarterial ventricular septal defect (sVSD) has a relatively high incidence in the Asian population. Surgical repair remains the preferred treatment. This research aims to report on the application of a modification of...
Subarterial ventricular septal defect (sVSD) has a relatively high incidence in the Asian population. Surgical repair remains the preferred treatment. This research aims to report on the application of a modification of the surgical approach in the treatment of sVSD in adolescents and adults; (2) METHODS: This retrospective cohort study included 74 consecutive patients aged 14 years or older with sVSD who underwent surgical repair between January 2016 and December 2024.Patients were divided into Group A (right axillary thoracotomy) and Group B (median sternotomy). Perioperative data and long-term follow-up outcomes were analyzed and compared; (3) Results: Baseline characteristics were comparable between groups. The right axillary thoracotomy group had longer cardiopulmonary bypass and aortic cross-clamp times but significantly lower postoperative drainage volumes. No significant differences were observed in mechanical ventilation time, intensive care unit stay, hospital length of stay, or pre-discharge ventricular function. During long-term follow-up, no deaths, reinterventions, residual shunts, or complete atrioventricular block occurred in either group; (4) Conclusions: In patients aged 14 years or older with sVSD, right axillary thoracotomy achieves perioperative and long-term outcomes comparable to conventional sternotomy, while offering advantages in reduced surgical trauma.
Network pharmacology and experimental evaluation of Sanwei Tanxiang Tangsan in doxorubicin-induced heart failure.
Aruna, Dulan, Damdinjav D … +3 more , Tungalag B, GuiZhi, Li H
J Cardiothorac Surg · 2026 Jun · PMID 42271471 · Full text
BACKGROUND: Heart failure (HF) is a complex syndrome characterized by inflammation, oxidative stress, and cardiomyocyte apoptosis, for which effective and well-tolerated therapies remain limited. This study sought to exp...
BACKGROUND: Heart failure (HF) is a complex syndrome characterized by inflammation, oxidative stress, and cardiomyocyte apoptosis, for which effective and well-tolerated therapies remain limited. This study sought to explore the potential mechanisms by which Mongolian medicine Sanwei Tanxiang Tangsan (STX) may be associated with AKT1/p53-related signaling in the mitigation of HF, employing network pharmacology, molecular docking, and animal experimentation. MATERIALS AND METHODS: Active constituents and corresponding targets of Mongolian medicine STX were systematically screened, followed by the construction of drug-disease interaction networks to identify pivotal proteins and pathways. A doxorubicin-induced HF rat model was established, and after four weeks of intragastric administration of Mongolian medicine STX and sacubitril/valsartan (angiotensin receptor-neprilysin inhibitor, positive control), cardiac functional parameters and expression levels of AKT protein 1 (AKT1), interleukin-6 (IL-6), and p53 were assessed. RESULT: Nineteen active components were identified in Mongolian medicine STX, interacting with 153 HF-associated targets, among which AKT1, IL-6, and TP53 served as the core genes. Molecular docking analysis revealed that quercetin and luteolin possessed moderate predicted binding affinities and stable interactions with the corresponding targets. Animal experiments indicated that Mongolian medicine STX significantly reduced N-terminal pro-brain natriuretic peptide levels and altered myocardial AKT1, IL-6, and p53 protein abundance. However, echocardiographic parameters showed no statistically significant improvement compared with the Model group. CONCLUSION: Mongolian medicine STX may exert cardioprotective effects in HF, as reflected by improvements in biochemical and histopathological indicators, and these effects may be associated with AKT1/p53-related signaling pathways. However, direct pathway activation and causal mechanisms were not confirmed in the present study and require further investigation.
Acute type a aortic dissection discovered by point of care ultrasonography (POCUS) in a patient with atypical abdominal pain: a case report.
Alasasfeh I, Alhawarat AA, Abdelrahim NM … +4 more , Nasr EB, Sabbah Q, Abunar AM, Al-Saafin A
J Cardiothorac Surg · 2026 Jun · PMID 42271451 · Full text
BACKGROUND: Acute aortic dissection (AAD) is a life-threatening emergency with a worldwide incidence of approximately 4.8 per 100,000 individuals annually. While chest pain is the hallmark symptom, atypical presentations...
BACKGROUND: Acute aortic dissection (AAD) is a life-threatening emergency with a worldwide incidence of approximately 4.8 per 100,000 individuals annually. While chest pain is the hallmark symptom, atypical presentations like abdominal pain can lead to significant diagnostic delays. CASE PRESENTATION: A 51-year-old male with hypertension presented with sudden, severe generalized abdominal pain. Physical examination revealed a rigid, tender abdomen and initial laboratory findings showed anemia (Hb 82 g/L) and elevated D-dimer. DIAGNOSTIC APPROACH: Bedside point-of-care ultrasonography (POCUS) was immediately performed, identifying an intimal flap in the aorta. Subsequent CT angiography confirmed a Stanford Type A dissection extending from the aortic valve to the common iliac arteries. CONCLUSION / LEARNING POINT: This case highlights the critical role of POCUS in the rapid diagnosis of AAD in patients with atypical symptoms. High clinical suspicion and early ultrasound intervention are essential for improving survival in unstable patients.
Outcomes of mechanical and bioprosthetic surgical valve replacements in egypt: evidence from a narrative review and experts' survey.
El Fiky M, Ahmed A, Sarawy E … +10 more , Ghanam ME, Sanad M, Mansour T, Elezbawy B, Fasseeh A, Essam S, Mowafy A, Abaza S, Salem A, Gamil E
J Cardiothorac Surg · 2026 Jun · PMID 42271450 · Full text
BACKGROUND: Selecting between mechanical and bioprosthetic valves depends on multiple clinical and patient-specific criteria. This study aims to compare mechanical and bioprosthetic valve replacement outcomes in Egypt to...
BACKGROUND: Selecting between mechanical and bioprosthetic valves depends on multiple clinical and patient-specific criteria. This study aims to compare mechanical and bioprosthetic valve replacement outcomes in Egypt to support evidence-informed decision-making. METHODS: We conducted a narrative literature review to identify studies reporting outcomes of mechanical and bioprosthetic valve replacements in Egypt. Findings were validated through an expert meeting with cardiothoracic surgeons. To capture real-world practice, an online survey was administered to cardiothoracic surgeons across Egypt. The narrative review and survey results were compared to global data to formulate recommendations on optimizing valve selection in Egypt. We extracted data from 41 eligible studies identified from the literature. RESULTS: Findings showed that unlike global data, reoperation rate in Egypt is lower with bioprosthetic valves compared to mechanical valves. Mechanical valves are associated with higher bleeding rates globally and locally. Survival and stroke incidence do not differ significantly between mechanical and bioprosthetic valves. The expert survey was responded to by 128 cardiothoracic surgeons. Experts predominantly used mechanical valves, highlighted age, and anticoagulation eligibility as the main factors influencing valve choice, and showed that longer clinical experience is associated with more tendency to use bioprosthetic valves. CONCLUSIONS: Valve type selection in Egypt should be individualized and made on a case-by-case basis due to the multiple factors influencing choice and outcomes. To support evidence-based decision-making, more local studies should be conducted, especially for bioprosthetic valves. These factors should be considered in selection to choose the most suitable valve for each patient.
Patient‑specific 3D‑printed Ti‑6Al‑4 V sternum-rib implant for near‑total sternal resection: operational blueprint, implant design principles, and intermediate clinical outcome.
Tripathi M, Ansari MI, Balachandran RR … +2 more , Kushwaha V, Dubey A
J Cardiothorac Surg · 2026 Jun · PMID 42271433 · Full text
BACKGROUND: Large sternal resections jeopardize chest-wall rigidity and cardiopulmonary protection. Conventional reconstructions often trade anatomical conformity for convenience. Three-dimensional planning and patient-s...
BACKGROUND: Large sternal resections jeopardize chest-wall rigidity and cardiopulmonary protection. Conventional reconstructions often trade anatomical conformity for convenience. Three-dimensional planning and patient-specific titanium (Ti-6Al-4 V) implants may reconcile oncologic goals with stable mechanics; however, detailed end-to-end workflows are seldom reported. METHODS: We implemented a CT-to-implant workflow - segmentation, virtual resection, CAD with lateral rib-coupling flanges and soft-tissue eyelets, polymer prototype rehearsal, additive manufacturing, and single-stage implantation - for a 28-year-old man with a sternal giant cell tumor. Near-total sternectomy was followed by rigid prosthetic fixation to a manubrial sliver, xiphoid remnant, and medial rib stumps. Double-layer polypropylene mesh (deep barrier and superficial buttress) and preserved pectoral muscle coverage enabled flap-less soft-tissue reconstruction. RESULTS: Estimated blood loss was 300 ml. The patient was extubated on table, the subcutaneous drain was removed on postoperative day 2, the intercostal drain on postoperative day 5, and total hospital stay was 5 days. Recovery was uncomplicated with oral-analgesic pain control and satisfactory early function. The cost of the prosthesis was INR 180,000 (approximately US$1,950). Final histopathology confirmed giant cell tumor with negative margins (R0 resection). Preoperative spirometry showed a restrictive pattern; repeat spirometry at approximately 1 month showed an overall improvement of about 20% in major parameters, although the original postoperative printout was not retrievable. At 6-month follow-up, the patient had resumed work and reported only intermittent mild pain not requiring analgesics. CONCLUSION: We present a pragmatic operational blueprint for patient-specific sternal reconstruction that highlights anchorage strategy, rib coupling, and soft-tissue suspension. The case demonstrates feasibility in a specialized multidisciplinary setting, but longer-term oncologic, functional, and implant-durability data remain necessary.
Development and validation of a predictive model for postoperative complications in thymoma patients.
Lu Z, Liu F, Yan D … +3 more , Wang J, Ma T, Ruan H
J Cardiothorac Surg · 2026 Jun · PMID 42271427 · Full text
OBJECTIVE: To develop and validate an intervention model for the risk factors of postoperative complications in patients with thymoma. METHODS: A retrospective analysis was conducted on the clinical data of patients who...
OBJECTIVE: To develop and validate an intervention model for the risk factors of postoperative complications in patients with thymoma. METHODS: A retrospective analysis was conducted on the clinical data of patients who underwent thymoma resection surgery at our hospital between June 2006 and July 2024. Postoperative complications were systematically categorized according to the Clavien-Dindo classification (Grade II-V), including but not limited to: ① 30-day mortality, ② respiratory failure (defined as mechanical ventilation > 48 h or unplanned reintubation), ③ myocardial injury (troponin elevation > 5×ULN).Whether complications occurred was divided into two groups. The data were randomly divided into a modeling cohort (70%) and a validation cohort (30%). Logistic regression was used to identify risk factors for postoperative complications, and model performance was evaluated using ROC curves and calibration plots. RESULTS: A total of 26.1% (66/253) of thymoma patients developed postoperative complications. Multivariable logistic regression analysis revealed that Masaoka-Koga stage, Myasthenia Gravis, intraoperative blood loss, forced expiratory volume in 1 second, and albumin were significant predictors in the model. The model demonstrated an area under the ROC curve of 0.84 (95% CI: 0.78-0.91) in the modeling cohort and 0.76 (95% CI: 0.63-0.89) in the validation cohort. The Hosmer-Lemeshow goodness-of-fit test showed: modeling cohort (χ2 = 5.0997, P = 0.6478), validation cohort (χ2 = 4.9946, P = 0.7582). Decision curve analysis indicated that the risk thresholds for the modeling and validation cohorts were 10%-70% and 10%-60%. CONCLUSION: This study developed a risk prediction model for postoperative complications in thymoma patients, demonstrating strong discriminative ability (C-statistic 0.82, 95% CI 0.78-0.86) and calibration (Brier score 0.11) upon internal validation. The model may aid in identifying high-risk patients for targeted preventive measures, though its impact on actual complication rates requires prospective intervention trials.
Prognostic impact of invasive features in completely resected NSCLC stratified by tumor diameter.
Furukawa N, Sakai T, Bunno Y … +4 more , Yamamoto M, Miyazaki R, Okada H, Tamura M
J Cardiothorac Surg · 2026 Jun · PMID 42271412 · Full text
BACKGROUND: In node-negative non-small cell lung cancer (NSCLC), only Pleural invasion (PI) is reflected in the current TNM staging, whereas the prognostic roles of Lymphatic invasion (LI) and Vascular invasion (VI) rema...
BACKGROUND: In node-negative non-small cell lung cancer (NSCLC), only Pleural invasion (PI) is reflected in the current TNM staging, whereas the prognostic roles of Lymphatic invasion (LI) and Vascular invasion (VI) remain poorly defined. Moreover, the variation in their prognostic impact across tumor size strata is not well understood. This study aimed to evaluate the prognostic impact of PI, LI, and VI on recurrence-free survival (RFS) in node-negative NSCLC, stratified by tumor size. METHODS: We retrospectively analyzed 692 patients with completely resected, node-negative NSCLC. Cases of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) were excluded from the analysis. Patients were categorized into three cohorts: Cohort1 (size: ≦ 2.0 cm), Cohort2 (> 2.0 cm ≦ 3.0 cm), and Cohort3 (> 3.0 cm ≦ 5.0 cm). Multivariate Cox regression analysis was performed to identify independent prognostic factors . RESULTS: In Cohort 1, PI (Hazard Ratio [HR]: 2.87, 95% Confidence Interval [CI]: 1.21-6.78, P = 0.02) was independent prognostic factors for worse RFS. In Cohort 2, only LI was significantly associated with recurrence (HR:3.62, 95% CI: 1.31-5.62, P = 0.01). In Cohort 3, both PI (HR:2.67, 95% CI: 1.24-5.79, P = 0.01) and LI (HR: 6.27, 95% CI: 2.79-14.1, P < 0.001) were independent predictors of poor prognosis, with LI demonstrating a more substantial impact than PI. VI showed limited prognostic value in larger tumors. CONCLUSION: The prognostic relevance of PI, LI, and VI in NSCLC varies by tumor size. PI plays a critical role in small tumors, while LI becomes increasingly influential with larger tumors. These findings suggest the need for size-specific pathological risk assessment to guide postoperative management and consideration of adjuvant therapy.
Totally thoracoscopic beating-heart tricuspid valve repair 30 years after Ebstein's anomaly surgery: a case report and literature review.
Li L, Zhao W, Huang C … +5 more , Bi X, Deng H, Yi D, Tan P, Xian L
J Cardiothorac Surg · 2026 Jun · PMID 42271403 · Full text
BACKGROUND: Ebstein's anomaly is a rare congenital malformation of the tricuspid valve that frequently progresses to severe tricuspid regurgitation and right-sided heart failure. Although early surgical repair can provid...
BACKGROUND: Ebstein's anomaly is a rare congenital malformation of the tricuspid valve that frequently progresses to severe tricuspid regurgitation and right-sided heart failure. Although early surgical repair can provide durable clinical improvement, late recurrent tricuspid regurgitation is not uncommon and may require technically challenging reoperation. In this setting, minimally invasive thoracoscopic beating-heart repair may offer an alternative to redo sternotomy, particularly for high-risk patients. CASE PRESENTATION: A 50-year-old woman with congenital tricuspid valve disease had previously undergone De Vega annuloplasty for Ebstein's anomaly at age 19. After more than three decades of clinical stability, progressive exertional dyspnea (New York Heart Association class III), abdominal distension, and bilateral leg edema developed. Evaluation demonstrated massive right atrial enlargement, severe tricuspid regurgitation, preserved left ventricular systolic function, and findings consistent with congestive hepatopathy. Following multidisciplinary evaluation, redo tricuspid valve repair was performed through a totally thoracoscopic right-sided approach using femoro-femoral cardiopulmonary bypass on a beating heart. The anterior and posterior leaflets were mobilized and augmented with a bovine pericardial patch to create a cone-like leaflet configuration, and a 30-mm annuloplasty ring was implanted. Intraoperative transesophageal echocardiography demonstrated trivial residual tricuspid regurgitation. Recovery was uneventful, and the patient was discharged on postoperative day 10. At 3-month follow-up, functional capacity improved, and echocardiography showed mild tricuspid regurgitation with reduced right-sided chamber dimensions. At the latest follow-up, 20 months after surgery, moderate residual tricuspid regurgitation persisted, while right-sided chamber dimensions remained reduced (right atrial transverse diameter, 64 mm; right ventricular transverse diameter, 44 mm). Chest radiography also showed persistent cardiomegaly, although it remained improved compared with the preoperative study. CONCLUSIONS: This case shows that totally thoracoscopic beating-heart tricuspid valve re-repair can be technically feasible in selected patients with late recurrent tricuspid regurgitation after prior Ebstein's anomaly surgery. In this patient, early postoperative improvement was substantial, although extended follow-up demonstrated partial loss of the initial echocardiographic benefit, highlighting the need for continued surveillance and cautious interpretation of long-term durability.
A comparative study of surgical repair of large atrial septal defects in adults using inferior mini-sternotomy and right axillary vertical mini-incision.
Xue C, He Y, Wang X … +3 more , CHen J, Zhang Y, Mu C
J Cardiothorac Surg · 2026 Jun · PMID 42271400 · Full text
BACKGROUND: Limited-access surgical repair remains important for adults with large atrial septal defects (ASDs) when transcatheter closure is unsuitable. This research aimed to compare early outcomes of inferior mini-ste...
BACKGROUND: Limited-access surgical repair remains important for adults with large atrial septal defects (ASDs) when transcatheter closure is unsuitable. This research aimed to compare early outcomes of inferior mini-sternotomy and right axillary vertical mini-incision for large ASD repair under cardiopulmonary bypass (CPB) without aortic cross-clamping. METHODS: This retrospective study included 79 adults from January 2020 to January 2024. Based on surgical approaches, patients were divided into Group A (n = 40, inferior mini-sternotomy) and Group B (n = 39, right axillary vertical mini-incision). Operative variables, postoperative recovery, pain scores, complications, costs, and 3-month follow-up findings were compared. RESULTS: All patients underwent successful repair without perioperative death, conversion, reoperation, major residual shunt, stroke, or low-output syndrome. Operative time, CPB duration, transfusion volume, duration of tracheal intubation, ICU stay, postoperative hospital stay, hospitalization cost, and myocardial injury markers were comparable between groups. Group B had higher pain scores on postoperative days 2 and 3 (P < 0.05). Pulmonary infection, pneumothorax, pleural effusion, and phrenic nerve palsy occurred only in Group B, whereas superficial wound infection, sternal malunion, and hypertrophic scar or keloid occurred only in Group A; most complication differences were not statistically significant. During 3-month follow-up, no death, reoperation, major residual shunt, cerebrovascular event, or severe rhythm-related event was observed. CONCLUSIONS: Both approaches enabled safe early large ASD repair on-pump CPB without aortic cross-clamping. Right axillary vertical mini-incision offered better scar concealment but greater early pain and pulmonary-management demands.
Two cases of typical left ventricular cardiac echinococcosis: a retrospective review with literature synthesis.
Xu X, Xu X, Shao Y … +6 more , Zhan F, Ye T, Zhang C, Liu R, Shen C, Wu M
J Cardiothorac Surg · 2026 Jun · PMID 42271391 · Full text
Echinococcus granulosus is a cestode parasite responsible for zoonotic hydatid disease. Humans acquire the infection by ingesting water or food contaminated with viable eggs, thereby serving as intermediate hosts. Althou...
Echinococcus granulosus is a cestode parasite responsible for zoonotic hydatid disease. Humans acquire the infection by ingesting water or food contaminated with viable eggs, thereby serving as intermediate hosts. Although the liver and lungs are the organs most frequently involved, cardiac involvement is rare and often clinically silent. The majority of patients seek medical attention due to symptoms of organ compression. At present, the standard management combines surgical removal with perioperative antiparasitic chemotherapy. Here we report two illustrative cases of cardiac echinococcosis involving the left ventricular wall and integrate them with previously published data to provide a comprehensive review of the diagnosis and treatment of cardiac echinococcosis. This review summarizes the key points throughout the entire treatment process of cardiac echinococcosis.
Evaluation of an unbalanced right dominant atrioventricular canal with a single 4D flow dataset.
Ream S, Schoeneberg L, King W
J Cardiothorac Surg · 2026 Jun · PMID 42271384 · Full text
Unbalanced atrioventricular (AV) canal anatomy presents a clinical challenge for the pediatric cardiology and cardiothoracic surgical team regarding the pre-operative assessment and ultimately, whether the optimal surger...
Unbalanced atrioventricular (AV) canal anatomy presents a clinical challenge for the pediatric cardiology and cardiothoracic surgical team regarding the pre-operative assessment and ultimately, whether the optimal surgery should consist of a univentricular or biventricular repair. We present such a case of a patient with an unbalanced, right dominant, AV canal where a novel approach to preoperative imaging utilizing a relatively brief cardiac MRI consisting of a single 4D flow dataset was used to accurately assess ventricular volumes and AV valve sizes. This pre-operative imaging assessment was instrumental in the decision-making process for a successful single ventricle palliation for this patient.
Global research trends and prognostic risk factors for ST-segment elevation myocardial infarction: a bibliometric analysis from 2003 to 2025.
Shang C, Wang Y, Chen Q … +2 more , Wu J, Wang Y
J Cardiothorac Surg · 2026 Jun · PMID 42265793 · Full text
BACKGROUND: Prognostic risk factors exert a critical influence on outcomes in patients with ST-segment elevation myocardial infarction (STEMI). However, global research trends and the primary determinants of research hot...
BACKGROUND: Prognostic risk factors exert a critical influence on outcomes in patients with ST-segment elevation myocardial infarction (STEMI). However, global research trends and the primary determinants of research hotspots remain to be fully elucidated. METHODS: A bibliometric analysis was conducted using CiteSpace and VOSviewer on 416 English-language publications retrieved from the Web of Science Core Collection database spanning 2003 to 2025. The analysis evaluated publication trends, contributions by country and institution, author productivity, journal impact, keyword co-occurrence, and citation networks. RESULTS: The annual number of publications demonstrated a steady increase, particularly post-2016, reflecting a surge in scientific interest. China emerged as the leading contributor in terms of publication output. Author analysis identified 115 core authors, with Gierlotka, Marek and Polonski, Lech being the most prolific. The collaborative author network revealed five major research clusters. BMC Cardiovascular Disorders was identified as the primary source journal, while Circulation exhibited the highest citation impact. Keyword co-occurrence and burst detection analysis highlighted evolving research focuses, including risk stratification, primary angioplasty, inflammation, heart failure, and biomarker-based prognosis. Key risk factors influencing STEMI prognosis included advanced age, diabetes, hypertension, obesity, acute kidney injury, cardiogenic shock, and cardiac arrest. Current research trends focus on biomarkers and scoring systems; specifically, there is a trend toward investigating target biomarkers such as CXCL16 and miR-146a, while scoring systems still require tools specifically tailored for STEMI. CONCLUSION: The field of STEMI prognosis research is progressively evolving. Current research hotspots are concentrated on risk factors affecting STEMI prognosis, the investigation of targeted biomarkers, and the development of risk stratificat.
Machine learning-based prediction of postoperative atrial fibrillation risk in coronary artery bypass grafting patients.
Zhang Y, Zhang Z, Zhang H … +4 more , Lu Y, Wang Z, Wei J, Feng S
J Cardiothorac Surg · 2026 Jun · PMID 42265777 · Full text
BACKGROUND: Postoperative atrial fibrillation (POAF) occurs in 20-40% of patients undergoing coronary artery bypass grafting (CABG) and is associated with increased morbidity and mortality. Existing machine learning (ML)...
BACKGROUND: Postoperative atrial fibrillation (POAF) occurs in 20-40% of patients undergoing coronary artery bypass grafting (CABG) and is associated with increased morbidity and mortality. Existing machine learning (ML) studies are limited by single‑center designs, small samples, and reliance on single algorithms. OBJECTIVE: To develop and internally validate a stacking ensemble ML model for predicting POAF after CABG, identify key predictors, and evaluate its incremental clinical value against conventional models. METHODS: A retrospective analysis of 563 CABG patients (29.5% POAF) from a single center was performed. After preprocessing, the dataset was split into training (n = 394) and validation (n = 169) sets. Features were selected using elastic net with stability selection (200 bootstrap resamples). Nine base ML algorithms and a stacking ensemble were built; hyperparameters were tuned via fivefold cross‑validation with overfitting controls. Model performance was assessed by discrimination, calibration, and decision curve analysis (DCA). RESULTS: Thirteen predictors were retained, with age, intraoperative phenylephrine use, and stroke history ranking highest. The stacking model achieved a validation AUC of 0.7425 and an F1 of 0.711. Logistic regression showed a comparable AUC (0.718, p = 0.09). The three clinical risk scores performed worse (AUCs 0.695, 0.662, 0.670; all p < 0.05). DCA revealed no net benefit below a threshold of 0.4, a marginal benefit (≈0.05) between 0.4 and 0.6, and no benefit above 0.6. CONCLUSION: The stacking model provides only moderate discrimination for POAF after CABG, with negligible net clinical benefit confined to a narrow threshold range. It is not ready for clinical use without external validation. The identified predictors may generate hypotheses for mechanistic studies, but their clinical utility remains unproven.
A rare presentation of pericardial cavernous hemangioma: case report.
Baker MA, Al-Aqra A, Sawalha A … +4 more , Nairat M, Abdul-Hafez HA, Majadla S, Sawalha N
J Cardiothorac Surg · 2026 Jun · PMID 42265767 · Full text
INTRODUCTION: Pericardial hemangiomas are exceedingly rare benign vascular cardiac tumors that may remain asymptomatic for years but can cause compression, arrhythmia, effusion, or heart failure when large. Early recogni...
INTRODUCTION: Pericardial hemangiomas are exceedingly rare benign vascular cardiac tumors that may remain asymptomatic for years but can cause compression, arrhythmia, effusion, or heart failure when large. Early recognition and definitive management are important to avoid morbidity. CASE PRESENTATION: A 56-year-old woman with well-controlled hypertension and diabetes presented with two months of progressive retrosternal chest heaviness and dyspnea. She reported a known intrapericardial mass monitored for 10 years. CT angiography revealed a well-circumscribed, vascularized intrapericardial mass (5.5 × 6.2 × 4.0 cm) compressing the left atrium with a central hypodense area; transthoracic echocardiography showed preserved left ventricular function (EF 60%). The patient underwent median sternotomy and complete surgical excision; intraoperative dissection identified vascular supply from the left circumflex artery. Histopathology confirmed a cavernous hemangioma (resected specimen 7.5 × 4.5 × 3.0 cm). The postoperative course was uneventful and she was discharged on postoperative day 4. DISCUSSION: Although uncommon, pericardial hemangiomas should be considered when imaging demonstrates vascular cardiac masses. Multimodality imaging aids planning; symptomatic lesions are best managed by complete surgical resection to relieve compression and prevent complications. CONCLUSION: This case illustrates successful surgical management of a symptomatic pericardial cavernous hemangioma and highlight the value of timely diagnosis and resection for optimal outcomes.
The impact of emergency intubation on surgical outcomes in patients with acute aortic dissection AADA (DeBakey I). Is a prompt treatment justified?
Arar M, Beckmann E, Martens A … +10 more , Helms F, Krueger H, Rudolph L, Deniz E, Todorov S, Schmitto J, Schmack B, Ruhparwar A, Shrestha M, Kaufeld T
J Cardiothorac Surg · 2026 Jun · PMID 42265728 · Full text
INTRODUCTION: An acute aortic dissection Stanford type A (AADA) is a life-threatening disease and one of the urgent emergencies in cardiovascular surgery. Furthermore, mortality increases when further risk factors like m...
INTRODUCTION: An acute aortic dissection Stanford type A (AADA) is a life-threatening disease and one of the urgent emergencies in cardiovascular surgery. Furthermore, mortality increases when further risk factors like malperfusion, cardiac tamponade or preoperative cardiopulmonary resuscitation (CPR) occur. This study retrospectively evaluates the impact of emergency intubation, performed prior to hospital admission, on early and long-term surgical outcomes in patients with acute aortic dissection Stanford type A (AADA, DeBakey Type I). METHODS: Between January 2000 and January 2018, 430 patients received aortic surgery due to an acute aortic dissection type A (DeBakey Type I) at our tertiary referral hospital. These patients were included in this study. The primary objective was to compare 30-day mortality and long-term survival between intubated and non-intubated AADA patients, while also analyzing differences in preoperative risk factors and postoperative complications. A retrospective analysis with follow-up was conducted. RESULTS: A minority (n = 55; 12.79%) of the entire cohort (n = 430) presented themselves in an intubated status and were assigned to Group A, whereas 375 patients were not intubated prior to surgery (Group B). The median age of the entire cohort of 430 patients was 63.7 years and 67.2% patients were male. Group A had a significantly higher number of patients with pericardial tamponade (Group A 58.2%; Group B: 34.7%) and an increased demand for mechanical resuscitation due to pulseless electrical activity (Group A: 29.1%; Group B: 5.9%). Preoperative malperfusion (Group A: 43.6%; Group B: 29.6%; p: 0.036) occurred significantly more often in the intubated cohort. Furthermore, Group A showed a higher number of supra-aortic artery dissections as well as neurological symptoms. The extent of the surgical treatment was comparable for both intubated and non-intubated patients. A total of 38.2% of the intubated AADA patients did not survive the first 30 days after surgery (Group A: 38.2%; Group B: 19.5%; p: 0.002). CONCLUSION: Prehospital intubated AADA patients present severe risk factors for early mortality, including pericardial tamponade, severe malperfusion and preoperative resuscitation. Despite the particularly early mortality rate of 40%, the majority of patients benefitted from prompt surgical treatment. Furthermore, the study presents an acceptable long-term outcome after surviving the initial first year after treatment. We therefore recommend that emergent aortic repair should be offered to intubated patients with AADA.
Libman sacks endocarditis with multivalvular involvement, hemorrhagic stroke, and concurrent mixed plasmodium malaria in systemic lupus erythematosus: a case report.
Khan A, Tahir O, Batool A … +6 more , Farman J, Javaid MH, Shehzad E, Soroush AR, Hassan F, Wazir HU
J Cardiothorac Surg · 2026 Jun · PMID 42265706 · Full text
BACKGROUND: The Libman-Sacks endocarditis (LSE) is a sterile inflammatory condition of the heart valves that occurs in the setting of systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Multivalvular...
BACKGROUND: The Libman-Sacks endocarditis (LSE) is a sterile inflammatory condition of the heart valves that occurs in the setting of systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Multivalvular affection is a known entity; however, it is not a common occurrence. The association between multivalvular LSE and hemorrhagic stroke is a very rare entity. CASE PRESENTATION: The case involves a 29-year-old female with a four-year history of SLE that had been diagnosed on the basis of the classification criteria formulated by EULAR and ACR in 2019. In addition, the patient reported fever that had been persisting over a period of ten days along with a condition of symmetrical polyarthritis that had lasted for three weeks following a pregnancy loss in the first trimester. It was documented that the patient was not compliant with immunosuppressive medications including her discontinuation of hydroxychloroquine, prednisolone, and mycophenolate mofetil. Encephalopathy followed which progressed rapidly enough to result in the development of unresponsiveness (Glasgow Coma Score 7/15). Physical examination showed that there was right hemiplegia along with bilateral extensor plantar response (Babinski sign). In terms of investigations, haemolytic anaemia was found (haemoglobin 6.0 g/dL), thrombocytopenia (platelet nadir 39 × 10³/µL), leukocytosis with neutrophilia (neutrophil count 14.2 × 10³/µL), significantly increased levels of inflammatory markers (CRP 42.2 mg/dL, ESR 120 mm/hr), anti-dsDNA level > 250 IU/mL, complement deficiency (C3 0.38 g/L; C4 0.05 g/L) and high titers of antiphospholipid antibodies (anticardiolipin IgG 72 GPL U/mL; anti-β2-glycoprotein I IgG 58 U/mL; lupus anticoagulant positive). Mixed infection caused by Plasmodium vivax and Plasmodium falciparum was confirmed through peripheral blood smear. The transthoracic echocardiography revealed presence of echogenic masses that were seen oscillating with adhesion to the posterior leaflet of mitral valve and aortic valve, associated with moderate to severe regurgitation from both valves, along with mitral stenosis, hence confirming multivalvular LSE. Cranial computed tomography without contrast revealed a large hemorrhagic infarct lesion (measuring 7 × 5.2 cm) in the left frontoparietal lobe with 15 mm midline shift. Management included administration of methylprednisolone pulses and artesunate for treating malaria, as well as blood products and osmotherapy using intravenous mannitol. Surgery was contraindicated due to presence of resistant thrombocytopenia and coagulopathy. The patient could not be managed despite maximal supportive treatment, and extremely poor prognosis was conveyed to the family. CONCLUSION: Multiple valvular Libman-Sacks endocarditis can lead to a hemorrhagic stroke due to the combination of embolic vegetations, vasculopathy related to lupus, and coagulation problems with thrombocytopenia. This is an example of how it is necessary for all SLE patients to be screened through echocardiography and tested for antiphospholipid antibodies, adherence to the drug regimen, and a multidisciplinary team approach.
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